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Wale at C.oh torn io—tnvlronmental Protection Age cy Form Approved OMB No.2050-0039(Expires 9- 0-99) See Instructions on back Of page 6. Department of Toxic Substances Control Please print or type. Form designed for use on e a(12-pitch)typewriter. Sacramento,California 1. UNIFORM HAZARDOU Generator's US EPA ID No. h Manifest Document No. 2. Page 1 Information in the shaded areas 6,;;�,c, is not required by Federal law. WASTE MANIFEST s', r- t .f� of 3. Generat•'•r's Name and Mailing Add ess (� s;,+ .-;:r•i..'� f:7 t ✓ «y,:� i A. State Manifest Document Number in.t 4 5 { l_p� 13�' �. c i e� u?PrF } t i--`=�. ry'f/�'t{ �� sty b.t N15 3'tS' T." B.A. �' •�•`�+ ' � r'f:'�,y, / 7 ."` B. State Generator's ID W) A. Generator's PhoneLO [ ) �J ' � 7'�`- "' 7r�.r,•, -. fV 5. Transporter 1 Company Name 6. US EPA ID Number C. State Transporter's ID[Reserved.] N ao T "i• D. Transporter's Phone 7. Transporter 2 Company Name 8. US EPA ID Number -- E.Stole Transporter's,ID.[Reserved,].. � .¢ F. Transporter's Phone "Y� U 9. Designated Facility Name and Site A dress 10. US EPA ID Number G. State Facility's ID - Z 255 PARR 8LVD. H. Facility's Phone �,�.�.•�! U 11. US DOT Description(including Prope Shipping Name,Hazard Class,and ID Number) 12. Containers 13. Total 14. Unit ,s `i, Et No. Type Quantity Wt/Vol I. Waste Number ;`el = 't.f� 5 JS C)LI D State _ k-1h.A''P1..._Y, a',>•P 0 1i�.,E TANK EPA/Other n �-r..Y f J 7 Cy {1 �.T 3 c C r.. ) CD N b. State do E N R EPA/Other A C. State o T a0D O R EPA/Other ac F- d. State r Z w U - EPA/Other U-1 'n J Additional Descriptions for_Materials Lis ed Above ! ,.. K. Handling Codes for Wastes Listed Above Z 9 2 ! ^+1 ,i;.ih',A ,C 1r;:NKii*� 01 d�6-nwd LU aed. -0- T5.-SPeCU146ndlin6 Instructions and Add lanae inrormonarr'- -`---- - �, .._...__-- Qcd - Z LU F- v t:r a.rz r ~i 16. GENERATOR'S CERTIFICATION: I here y declare that the contents of this consignment are fully and accurately described above by proper ship ing name and are classified,packed,' U marked,and labeled,and are in all re pects in proper condition for trans ort b hi hwa accordin to a y p U P Y 9 Y g pplicable international and national government regulations. N—J If 1 am a large quantity generator,I ce tify that I have a program in place to reduce the volume and toxicity of waste generated to the degree I have determined to be economic 11 practicable and that I have selected the practicable method of treatment,storage,or disposal currently available to me which minimizes the present and future threat to human health and the environment;OR,if I am a sm II quantity generator,I have made a good faith effort to minimize mesas-te generation and select the best waste management method that is Q available to me and that I can afford. L } Printed/Typed Name t �{ t U 1 Signature`- r nth+ Day Year / \ .+%' l y (� T 17. Transporter 1 Acknowled ement of Rece t of Materials �' It c. LU 5 PrintedTyped Nam Sig}nprl Month) Day Year 7..•• P - .w . LLJ U_ B 18. Trans orter 2 Acknowled ement of Recei t of Materials T Printed/Typed Name ts.t E ' Signature Month Day Year to R Q U F 19. Discrepancy Indication Space L L if yid , 4?,t � ✓r:J,c;, I.i + � '/ r �f� "- _ 7't;err/. A •rr ' 20. Facility Owner or O orator Certification o recei t of hazardous materials covered b this manifest exce t as noted in Item 19. YPrinted/Typed Name r/ , t Signature - - - Month Day Year s f� ..� J• �]l./..o !i/i Y. r 4-' ::fit ✓ lr� Y'••e} DO NOT WRITE BELOW THIS LINE. '41; Yellow: TSDF SENDS THIS Q Y TO R OI; WITHIN S. DTSC 8022A(1/99) (Generators who s' haz � art, 'Of-state, EPA 8700-22 produce completed'� of this copy a AS DT ithin 30 days